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. 2024 Feb 1;159(2):151-159.
doi: 10.1001/jamasurg.2023.6031.

Surgeon Sex and Health Care Costs for Patients Undergoing Common Surgical Procedures

Christopher J D Wallis  1   2   3 , Angela Jerath  4 , Khatereh Aminoltejari  1 , Kirusanthy Kaneshwaran  4 , Arghavan Salles  5 , Melinda Beeuwkes Buntin  6 , Natalie G Coburn  7 , Frances C Wright  7 , Lesley Gotlib Conn  7 , Kiyan Heybati  8 , Amy N Luckenbaugh  9 , Sanjana Ranganathan  10 , Carlos Riveros  10 , Colin McCartney  4 , Kathleen A Armstrong  11 , Barbara L Bass  12 , Allan S Detsky  13   14   15 , Raj Satkunasivam  10   16   17
Affiliations

Surgeon Sex and Health Care Costs for Patients Undergoing Common Surgical Procedures

Christopher J D Wallis et al. JAMA Surg. .

Abstract

Importance: Prior research has shown differences in postoperative outcomes for patients treated by female and male surgeons. It is important to understand, from a health system and payer perspective, whether surgical health care costs differ according to the surgeon's sex.

Objective: To examine the association between surgeon sex and health care costs among patients undergoing surgery.

Design, setting, and participants: This population-based, retrospective cohort study included adult patients undergoing 1 of 25 common elective or emergent surgical procedures between January 1, 2007, and December 31, 2019, in Ontario, Canada. Analysis was performed from October 2022 to March 2023.

Exposure: Surgeon sex.

Main outcome and measure: The primary outcome was total health care costs assessed 1 year following surgery. Secondarily, total health care costs at 30 and 90 days, as well as specific cost categories, were assessed. Generalized estimating equations were used with procedure-level clustering to compare costs between patients undergoing equivalent surgeries performed by female and male surgeons, with further adjustment for patient-, surgeon-, anesthesiologist-, hospital-, and procedure-level covariates.

Results: Among 1 165 711 included patients, 151 054 were treated by a female surgeon and 1 014 657 were treated by a male surgeon. Analyzed at the procedure-specific level and accounting for patient-, surgeon-, anesthesiologist-, and hospital-level covariates, 1-year total health care costs were higher for patients treated by male surgeons ($24 882; 95% CI, $20 780-$29 794) than female surgeons ($18 517; 95% CI, $16 080-$21 324) (adjusted absolute difference, $6365; 95% CI, $3491-9238; adjusted relative risk, 1.10; 95% CI, 1.05-1.14). Similar patterns were observed at 30 days (adjusted absolute difference, $3115; 95% CI, $1682-$4548) and 90 days (adjusted absolute difference, $4228; 95% CI, $2255-$6202).

Conclusions and relevance: This analysis found lower 30-day, 90-day, and 1-year health care costs for patients treated by female surgeons compared with those treated by male surgeons. These data further underscore the importance of creating inclusive policies and environments supportive of women surgeons to improve recruitment and retention of a more diverse and representative workforce.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Buntin reported being an unpaid member of the Board of the Harvard Medical Faculty Practice and deputy editor of JAMA Health Forum. Dr Wright reported being a consultant for Cancer Care Ontario–Ontario Health (the provincial cancer agency). Dr Jerath reported receiving grants from the Department of Anesthesiology and Pain Medicine, University of Toronto Merit Award and from the Womens' Heart and Brain Award, Health Canada, Heart and Stroke Foundation of Canada during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Cohort Derivation
Figure 2.
Figure 2.. Association Between Surgeon Sex and Health Care–Related Costs for Patients Undergoing Common Surgical Procedures in Ontario, Canada
Error bars indicate 95% CIs. The 2020 CAD to USD conversion was approximately 1.34 CAD per 1 USD.
Figure 3.
Figure 3.. Subgroup Analysis Assessing the Association Between Surgeon Sex and Total Health Care Costs at 1 Year, Stratified by Surgeon, Patient, Anesthesiologist, Procedure, and Hospital Characteristics
See this image and copyright information in PMC

Comment in

References

    1. Wallis CJ, Ravi B, Coburn N, Nam RK, Detsky AS, Satkunasivam R. Comparison of postoperative outcomes among patients treated by male and female surgeons: a population based matched cohort study. BMJ. 2017;359:j4366. doi:10.1136/bmj.j4366 - DOI - PMC - PubMed
    1. Wallis CJD, Jerath A, Coburn N, et al. . Association of surgeon-patient sex concordance with postoperative outcomes. JAMA Surg. 2022;157(2):146-156. doi:10.1001/jamasurg.2021.6339 - DOI - PMC - PubMed
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    1. Wallis CJD, Jerath A, Kaneshwaran K, et al. . Association between surgeon and anesthesiologist sex discordance and postoperative outcomes: a population-based cohort study. Ann Surg. 2022;276(1):81-87. doi:10.1097/SLA.0000000000005495 - DOI - PubMed

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